Sensation In Chest Research Articles

The development of the Cough Hypersensitivity Questionnaire for chronic cough.

Chronic cough is considered a disorder of neuronal hypersensitivity in which patients frequently report abnormal laryngeal and chest sensations, and excessive triggers. To facilitate clinical assessment, we developed the Cough Hypersensitivity Questionnaire (CHQ). Candidate questionnaire items were developed following interviews with patients with refractory chronic cough (n=10, United Kingdom), and review by a multidisciplinary team. The CHQ was evaluated in individuals with chronic cough (n=535, UK/South Korea), for unidimensionality and differential item functioning (with Rasch analysis), internal consistency, concurrent validity (against cough severity visual analogue scale (VAS) and Leicester Cough Questionnaire (LCQ) scores), and content validity (cognitive debriefing interviews, n=13). Concept elicitation created a pool of 34 items. Eleven items were removed following multidisciplinary team review of patient interviews. Rasch analysis confirmed the CHQ total score to be a unidimensional scale; one item was removed due to differential item functioning. The final 22 binary-item CHQ comprises 6 sensation-related and 16 trigger-related items. Median (interquartile range) total CHQ scores were 9 (6-12); sensations 4 (2-5) and triggers 5 (3-8). Internal consistency was good (person separation index 0.74). The CHQ total score was moderately associated with cough severity VAS (0.42, p=0.005) and LCQ total score (ρ=-0.52, p<0.001). In cognitive debriefing, patients found that the CHQ was relevant to their condition and simple to complete. The CHQ is simple to use and has validity for assessing cough triggers and sensations in patients with chronic cough. Further studies are needed to assess its repeatability, responsiveness and clinical utility.

Prospective Sensory Outcomes for Targeted Nipple Areola Complex Reinnervation (TNR) in Gender-Affirming Double Incision Mastectomy with Free Nipple Grafting.

This study analyses the anatomy and sensory outcomes of targeted nipple areola complex reinnervation (TNR) in gender-affirming double incision mastectomy with free nipple grafting (FNG). TNR is a novel technique to preserve and reconstruct intercostal nerves (ICN) to improve postoperative sensation. There is little evidence on relevant anatomy and outcomes. 25 patients were prospectively enrolled. Data included demographics, surgical technique, and axon/fascicle counts. Quantitative sensory evaluation using monofilaments and qualitative patient reported questionnaires were completed preoperatively, and at one, three, six, nine and twelve months postoperatively. 50 mastectomies were performed. Per mastectomy, the median number of ICN found and used was 2 (1-5). Axon and fascicle counts were not significantly different between ICN branches ( P >0.05). BMI ≥30kg/m 2 and mastectomy weight ≥800g were associated with significantly worse preoperative sensation ( P <0.05). Compared to preoperative values, NAC sensation was worse at 1 month ( P <0.01), comparable at 3 months ( P >0.05), and significantly better at 12 months ( P <0.05) postoperatively. Chest sensation was comparable to the preoperative measurements at 1 and 3 months ( P >0.05), and significantly better at 12 months ( P <0.05) postoperatively. NAC sensation was significantly better when direct coaptation was performed compared to use of allograft only ( P <0.05), and with direct coaptation of ≥2 branches compared to direct coaptation of a single branch ( P <0.05). All patients reported return of nipple and chest sensation at one year postoperatively and 88% reported return of some degree of erogenous sensation. TNR allows for restoration of NAC and chest sensation within 3 months postoperatively. Use of multiple ICN branches and direct coaptation led to the best sensory outcomes.

A Comparative Clinical Study on Effect of Samsaptak Choorna and Avipattikar Choorna in Management of Amlapitta

Introduction: In this modern era, we all are undergoing different lifestyle modification related to food and lifestyle. Irregular meal pattern, work in shift duties, irregular sleep timing, craze for fast food, anxiety, and stress-induced hectic unhealthy schedules cause various disorders due to which there has been an extraordinary increase in the disorders related to Annavahasrotas or the gastrointestinal (G.I) system. Burning sensation in chest, sour belching, abdominal discomfort, nausea, vomiting, headache, and constipation are the most common complaints faced in day-to-day life. All these symptoms point toward Amlapitta in Ayurveda. If left untreated, it may lead to complications such as ulcerations in the gastrointestinal tract and forward the known medications such as Avipattikar Choorna andSamsaptak Choorna are taken for the study to evaluate their effect and compare their effect.Materials and Methods: 20 patients of Group A were treated with Samsaptak Choorna for 30 days. 20 patients of Group B were treated with Avipattikar Choorna for 30 days’ 20 patients in each group and both groups subjected to Amlapitta treatment: In the first group, doses of Samsaptak Choorna 3 g BID per day in divided doses for period of 30 days and in the second group, doses of AvipattikarChoorna 3 g BID per day in divided doses for period of 30 days.Results: The result of both groups was analyzed statistically and compared and results were interpreted in the term of increase or decrease in the parameter. The statistical analysis reveals that both the groups are showing good result but Group B is slightly more effective result then Group A in Amlapitta.

Outcomes of Transaortic Celiac Plexus Block for Upper Abdominal Malignancies Performed as a Day-care Procedure: A Retrospective Observational Study

Background: Severe abdominal pain refractory to opioids significantly affects the quality of life (QoL) in patients with abdominal primary cancer or metastatic disease. A neurolytic celiac plexus block (CPB) would be necessary to alleviate pain and improve QoL until death. Aims: The aim of this retrospective study is to investigate pain relief after a transaortic celiac plexus neurolysis for patients with upper gastrointestinal malignancies. Settings and Design: This retrospective observational study was done in the Pain Department, Shri Siddhivinayak Cancer Hospital, Miraj from January 2005 to January 2015. Materials and Methods: One hundred and twenty-four patients with upper abdominal malignancy received a computed trans-aortic celiac plexus block (TAoCPB) on a day-care basis. The primary outcome was pain as assessed with numerical rating scale ranging from 0 to 10; the secondary outcome measures were morphine consumption per day, QoL, and complications, if any. These were recorded before intervention, on day 1 after the block and at 1 month interval until 6 months. Statistical Analysis Used: Bonferroni correction for multiple comparisons and a P &lt; 0.0167 (0.05/3) was considered to be statistically significant due to 3 co-primary outcomes being measured (visual analog scale [VAS] scores, morphine consumption, and QoL). Results: Up to 4.5 months, the VAS score, daily morphine consumption, and the QoL showed improvement for the duration of the study. Pain gradually increased at 6 months with a deterioration of QoL. Respiratory distress and burning sensation in chest occurred in one patient each. Conclusions: A low-volume TAoCPB is effective and established procedure as a day-care procedure. Although pain relief occurs until 4.5 months, a gradual increase was perceived with a decline of quality of health at 6 months.

Nerve-Preserving Superomedial Pedicle Breast Reduction Approach for Chest Wall Masculinization: A Case Report

Introduction: Gender affirming chest surgeries are a treatment for transgender and gender diverse individuals who suffer from gender dysphoria. Double incision mastectomy with free nipple grafts is the most common technique used for masculinization of the chest for Fischer grade 2B to 4 patients. However, this technique sacrifices the nerves to the nipple-areolar complex (NAC). While multiple nipple pedicles have been described in cisgender reduction mammoplasty, only an inferior pedicled mammaplasty approach has been described for chest wall masculinization for Fischer grade 2B to 4 patients. Case Presentation: We describe the surgical technique of a superomedial pedicle chest masculinization surgery for an individual with Fischer grade 2B breasts. Sensation was preserved at 2-weeks post-surgery. At 4-months, using a 0 to 10 numeric rating scale, patient satisfaction was 9 for the overall cosmetic outcome and a 9 for the masculinization. Using inferior sternum sensation as a reference (10), areola sensation on the superior side adjacent the nipple was a 6.5 on the right and an 8 on the left. Chest sensation was a 10 in the superolateral, inferolateral, and superomedial quadrants bilaterally, and was an 8 in bilateral inferomedial quadrants. 2-point discrimination of the areola was assessed on the inferior side adjacent the nipple and was 13mm on the left and 14mm on the right. Semmes-Weinstein monofilament testing of the areola was performed adjacent to the nipple superiorly (R: 4.31, L: 4.56), inferiorly (R: 4.31, L: 6.65), medially (R: 4.31, L: 6.65), and laterally (R: 4.31, L: 6.65). Conclusion: A mastectomy technique using a superomedial pedicle can preserve the nerve to the nipple-areolar complex to retain sensation while providing sufficient cosmetic outcome.

Long QT syndrome with potassium voltage-gated channel subfamily H member 2 gene mutation mimicking refractory epilepsy: case report

BackgroundEpileptic seizures can be difficult to distinguish from other etiologies that cause cerebral hypoxia, especially cardiac diseases. Long QT syndrome (LQTS), especially LQTS type 2 (LQT2), frequently masquerades as seizures because of the transient cerebral hypoxia caused by ventricular arrhythmia. The high rate of sudden death in LQTS highlights the importance of accurate and early diagnosis; correct diagnosis of LQTS also prevents inappropriate treatment with anti-epileptic drugs (AEDs).Case presentationWe report a case of congenital LQT2 with potassium voltage-gated channel subfamily H member 2 gene (KCNH2) mutation misdiagnosed as refractory epilepsy and treated with various AEDs for 22 years. The possibility of cardiac arrhythmia was suspected after the patient presented to the emergency room and the electrocardiograph (ECG) monitor showed paroxysmal ventricular tachycardia during attacks. Atypical seizure like attacks with prodromal uncomfortable chest sensation and palpitation, triggered by auditory stimulation, and typical ventricular tachycardia monitored by ECG raised suspicion for LQT2, which was confirmed by exome sequencing and epileptic seizure was ruled out by 24-h EEG monitoring. Although the patient rejected implantation of an implantable cardioverter defibrillator, β blocker was given and the syncope only attacked 1–2 per year when there was an incentive during the 5 years follow up.ConclusionsOur case illustrates how long LQTS can masquerade convincingly as epilepsy and can be treated wrongly with AEDs, putting the patient at high risk of sudden cardiac death. Careful ECG evaluation is recommend for both patients with first seizure and those with refractory epilepsy.

The Ayurvedic Management of Urdhwaga Amlapitta with Vamana.

The Amlapitta is one of the most common disease of Annavaha Srotas which bears the direct impact of the dietic errors that a person indulges. Amlapitta Vyadhi is complex of symptoms correlated with acid peptic disease/gastritis/hyperacidity described in modern medicine science.Many new drugs are available like antacids, proton pump inhibiters,H2 blockers, in modern medicine system but all they provides symptomatic relief instead of complete cure of disease and they also have adverse effects.The case of Amlapitta was treated with Vamana (Therapeutic emesis) therapy, as indicated in Kashyap Samhita. A 53 years old female patient presented with complaints of Chardi(Vomiting), Hritkanthadaha(burning sensation in chest and throat), Tikta-Amlodgara(Acid eruction with bitter and sour taste and Hrullas( Nausea) since 1 year.Dadimashtak Churna for Deepan, Pachana.Panchatikta ghrit for internal oleation was used .External oleation and sudation was done with Nirgundi oil .Vamana dravya madanphal phant while Yashtimadhu Kwatha was used for Aakanthapan as Vamanopaga dravya.On the follow up day it was seen that patient got complete relief from Chardi, Hritkanthadaha while significant improvement was seen in Hrullas and Tikta-Amlodgara and there was no recurrence of disease seen . Thus Vamana therapy is effective in patient of Urdhwaga Amlapitta.The Amlapitta is one of the most common disease of Annavaha Srotas which bears the direct impact of the dietic errors that a person indulges. Amlapitta Vyadhi is complex of symptoms correlated with acid peptic disease/gastritis/hyperacidity described in modern medicine science.Many new drugs are available like antacids, proton pump inhibiters,H2 blockers, in modern medicine system but all they provides symptomatic relief instead of complete cure of disease and they also have adverse effects.The case of Amlapitta was treated with Vamana (Therapeutic emesis) therapy, as indicated in Kashyap Samhita. A 53 years old female patient presented with complaints of Chardi(Vomiting), Hritkanthadaha(burning sensation in chest and throat), Tikta-Amlodgara(Acid eruction with bitter and sour taste and Hrullas( Nausea) since 1 year.Dadimashtak Churna for Deepan, Pachana.Panchatikta ghrit for internal oleation was used .External oleation and sudation was done with Nirgundi oil .Vamana dravya madanphal phant while Yashtimadhu Kwatha was used for Aakanthapan as Vamanopaga dravya.On the follow up day it was seen that patient got complete relief from Chardi, Hritkanthadaha while significant improvement was seen in Hrullas and Tikta-Amlodgara and there was no recurrence of disease seen . Thus Vamana therapy is effective in patient of Urdhwaga Amlapitta.

Efficacy of Indukanta ghritam in the management of Jirna urdhwaga amlapitta: A case report

Amlapitta (~hyperacidity) is a disease of Annavaha srotas (~gastrointestinal tract) that originates from Amasaya (~stomach). Mandagni (~low digestive fire) plays an important role in its manifestation. The disease is easy to treat in its early stage while difficult to manage in chronic stage. It can cause various complications if not treated early. The disease has close resemblance with acid peptic disorder or hyperacidity. Various treatment modalities are available in conventional medical science, but they have certain limitations. In Ayurveda, various herbs, minerals, and their compound formulations have been mentioned in its management, and Indukanta ghritam is one among such formulations. In the present case report, a 17-year-old female with complaints of Amlodgara (~sour belching), Hritkanthadaha (~burning sensation in throat and chest), Utklesha (~nausea) and Chardi (~vomiting), Avipaka (~indigestion), Shiroruja (~headache), and Vibandha (~constipation) visited outpatient department. The condition was diagnosed as Jirna urdhwaga amlapitta. Indukanta ghritam and wholesome dietary regimen were given to the patient for 28 days. The results suggested that the patient was benefited in all symptoms within 28 days. However, the Shamana therapy was continued for 50 days. The patient, after two months of follow-up, presented without any complications.

A case report of somatic symptom disorder as first manifestation of semantic dementia

Abstract Semantic dementia (SD) is a progressive neurodegenerative disorder in which patients present a loss of meaning of words, objects, and concepts. SD has been linked with alexisomia, as well as somatic symptom disorder (SSD). A 65 year-old patient with a 2-year history of daily episodes of pulsatile head and chest sensations followed by prostration with maintained awareness was diagnosed with SSD. The patient was subsequently admitted into an epilepsy unit to exclude the diagnosis of epileptic seizures. Clinical, neuropsychological, and neuroimaging assessments were consistent with the diagnosis of probable SD. This case report presents a patient whose first manifestation of SD was SSD, thus highlighting the importance of both careful clinical and neurocognitive enquiry, and caution in diagnosing SSD in later life. This case outlines the association between SD and somatic symptoms, providing insight into the nature of alexisomia and the emergence of SSD in SD.

Clinical trials of treatment of woman menopause insomnia due to disharmony between heart and kidney by body and auricular acupuncture

To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney. A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group (n＝55, body acupoints plus auricular points) and control group (n＝56, body acupoints). For control group, Shenmen (HT7), Sanyinjiao (SP6), Anmian, Zhaohai (KI6), Shenmai (BL62), Sishencong (EX-HN1), Xinshu (BL15) and Shenshu (BL21) were needled with filiform needles, and HT7, SP6, Anmian, BL15 and BL21 were also stimulated with electroacupuncture (EA) for 30 min, once every other day, 3 times a week for 3 weeks. For the treatment group, auricular points as Kidney, Shenmen, Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group. The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index (PSQI) scale before and after the treatment. The symptom scores of traditional Chinese medicine (TCM) and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM" (formulated by Chinese Ministry of Health, 1997). After the treatment, the scores of sleep quantity and effective rate of PSQI scale, and those of insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, paplpitation and irritability, fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment (P<0.05). Of the 56 and 55 cases in the control and treatment groups, 18 (32.1%) and 30 (54.5%) experienced a marked improvement in their symptoms, 28 (50.0%) and 22 (40.0%) were effective, and 10 (17.9%) and 3 (5.5%) failed, with the effective rate being 82.1% and 94.5%, respectively. The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale, insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, dizziness and tinninus, paplpitation and irritability, and tital fever and night sweating of TCM, as well as the effective rate (P<0.05). Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney, and the two combined treatment was evidently better.

Disappearance of ventricular ectopics following 15-day practice of Pal's pranayama schedule

A 56‑year‑old male presented to the Cardiology Outpatient Department with symptoms of left‑sided chest pain and sensation of dropped beats for the last 5 days. The chest pain was diffuse and not associated with radiation to left arm or sweating. Fifteen days of practice of Pal’s pranayama schedule resulted in disappearance of chest discomfort and abolition of ventricular ectopics.

Clinical characteristics and outcome comparison between atrial fibrillation patients underwent catheter ablation under general aesthesia or local anesthesia and sedation

Objective: To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Methods: Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Patients were followed clinically every 3 months within one year after procedure. Immediate electrocardiogram was performed in patients with palpitation or choking sensation in chest. The end point of the study was recurrence of any atrial tachyarrhythmia lasting >30 seconds in device interrogation, 24-hour Holter monitoring or 12-lead electrocardiogram after a single procedure. After the ablation procedure, a blanking period of 3 months was allowed according to the guidelines. Procedure time, radiofrequency time, fluoroscopy time, the detection of paroxysmal supraventricular tachycardia, the success rate and the complications were compared between the two groups. Results: There was no difference in the baseline characteristics between the two groups, such as age, gender, BMI, complications, LVEF, LAD (all P>0.05). The duration of procedure ((117.8±51.7)minutes vs.(115.4±36.9)minutes, P=0.79), duration of fluoroscopy((12.5±11.2)minutes vs. (10.4±10.2)minutes, P=0.35), duration of radiofrequency((40.1±12.9)minutes vs. (48.6±44.3)minutes, P=0.48) were similar between the two groups (P>0.05). Compared with S group, discovery of the frequency of atrioventricular node reentrant tachycardia (AVNRT) was significantly lower in GA group (0 vs. 3.6%(10/278), P<0.01), but the difference disappeared with repeat electrophysiological examination when patients become conscious from GA(3.2%(7/220) vs. 3.6%(10/278), P=0.311). The difference of atrioventricular reentrant tachycardia (AVRT) was similar between the two groups(0.9%(2/220) vs. 0.7%(2/278), P=0.841). Compared with S group, reflection of vagus nerve was less in GA group (1.4%(3/220) vs. 8.6%(24/278), P=0.026). After following up of (356±92) days, freedom from atrial fibrillation/atrial flutter/atrial tachyarrhythmia was similar between the two groups(77.9%(162/208) vs. 79.9%(215/269), P=0.818). Conclusion: General anesthesia is a promising method to atrial fibrillation ablation, in view of stable patient status and safety for the procedure. There is no difference in complications, recurrence of arrhythmia between the two groups, but detection rate of AVNRT is lower in GA group.

The significance of preservation of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach

Objective: To evaluate the significance for the preservation of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach. Methods: We retrospectively evaluated 168 patients who underwent unilateral endoscopic thyroidectomy via gasless anterior chest approach, with preservation of the medial branch of the supraclavicular nerve in 110 patients and not in other 58 patients. Semmes-Weinstein monofilament (SWM) test and a visual analogue scale (VAS) were used to assess the recovery of sensation in anterior chest within 1-12 months postoperatively. Difference in the scores of SWM or VAS between groups was tested with Mann-Whitney U test, and the rates of SWM and VAS scores returning to normal levels in individual periods after surgery was compared with Chi-square test. Results: The preserved group showed more favorable results than the non-preserved group in both SMW and VAS scores. Compared to control group, SWM score in preserved group possessed a higher rate recovery to normal level at any period after operation, which was close to complete normality in 7-9 months postoperatively, and SWM score in non-preserved group was still partially normal in 10-12 months from surgery. Preferable results for VAS were also found in the preserved group, except no significant difference in VAS between groups in1-3 months or 10-12 months after operation. Conclusion: Preservation of the medial branch of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach can improve sensation recovery in anterior chest, thus improving postoperative quality of life of patients.

Management of Urdhvaga Amlapitta with Vamana: A Case Study

Amlapitta is a disease of Annahava Srotas and is more common in the present scenario of unhealthy diets and regimens. The case of Amlapitta, was managed with Vamana, one of the Panchakarma therapy, as indicated in ‘Kashyap Samhita.’ Case: A 29 year old male patient presented with complaints of pitta udiran, sour belching (amlodgara), burning sensation in throat and chest (hritkanthadaha), indigestion (avipaka) and ajeerna since 2 years. Management: Pachan was done with Hingvashtak churna. Internal oleation with Kantakari ghrita in increasing dose. External oleation and sudation was done with Sesame oil. For Vamana Akantha pan godugdha was used. Vamana dravya was madanphala churna (2gm), yashtimadhu churna (2gm), vacha churna (1gm), saindhav (2gm) (chatan with madh). Yashtimadhu kwath was used as Vamanaopag dravya. Result and conclusion: The patient was asked for follow-up after 7 days. Then the patient was asked to come for follow-up after every six months. It was seen that patient got complete relief from pitta udiran, sour belching (amlodgara), burning sensation in throat and chest (hritkanthadaha), indigestion (avipaka) and indigestion (ajeerna) on day 7. And it also seen that there was no recurrence of Amlapitta even after one and half year. Thus Vamana therapy in patient of Amlapitta is effective and shows long term relief from the symptoms.

Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals.

While most people take identification with their body for granted, conditions such as phantom limb pain, alien hand syndrome, and xenomelia suggest that the feeling of bodily congruence is constructed and susceptible to alteration. Individuals with xenomelia typically experience one of their limbs as over-present and aversive, leading to a desire to amputate the limb. Similarly, many transgender individuals describe their untreated sexed body parts as incongruent and aversive, and many experience phantom body parts of the sex they identify with (Ramachandran, 2008). This experience may relate to differences in brain representation of the sexed body part, as suggested in xenomelia (McGeoch et al., 2011). We utilized magnetoencephalography imaging to record brain activity during somatosensory stimulation of the breast-a body part that feels incongruent to most presurgical female-to-male (FtM)-identified transgender individuals-and the hand, a body part that feels congruent. We measured the sensory evoked response in right hemisphere somatosensory and body-related brain areas and found significantly reduced activation in the supramarginal gyrus and secondary somatosensory cortex, but increased activation at the temporal pole for chest sensation in the FtM group (N=8) relative to non-transgender females (N=8). In addition, we found increased white matter coherence in the supramarginal gyrus and temporal pole and decreased white matter diffusivity in the anterior insula and temporal pole in the FtM group. These findings suggest that dysphoria related to gender-incongruent body parts in FtM individuals may be tied to differences in neural representation of the body and altered white matter connectivity.

Outcome of Paraquat Poisoned Patients Treated with a Commonly Used Therapeutic Flowchart: A Case Series

Background: Paraquat poisoning is a medical emergency challenge due to its inherent severe toxicity and unavailability of specific antidote for it. In this paper, a series of patients who were treated according to a commonly used treatment flowchart are presented. Methods: This prospective observational study was carried out on paraquat poisoned patients admitted to District Hospital, Chamarajanagar and Shimoga institute of Medical Sciences, Shimoga, Karnataka, India, during January 2013 to December 2014. Results: Six patients (4 women and 2 men) with median age of 23 [min-max: 18-42] years were studied. The majority of patients had respiratory distress (with an average SpO2 of 60%), i.e. 4 out of 6 cases manifested with respiratory distress associated with dryness and burning sensation in mouth, throat and chest. Oxygen therapy with mask in one case and by ventilator in rest of cases was required. Except one patient who died on the first day and no further measurement of serum creatinine could be taken from her, all other patients developed increased creatinine. Five out of 6 patients died mainly due to pulmonary sequels. In the only survived patient, gastrointestinal symptoms were predominant followed by acute renal failure and pulmonary congestion which were reverted with medical care indicated in the therapeutic flowchart. In post-mortem investigations, inflammatory infiltration in lungs was noted in all cases and acute tubular necrosis was seen in 3 cases. Conclusion: Renal insufficiency and pulmonary damage following severe paraquat poisoning are indicators of poor prognosis and may not be reversible with commonly used treatment approaches.

Patients' experience of identifying and managing exacerbations in COPD: a qualitative study.

Background:Effective self-management in chronic obstructive pulmonary disease (COPD) is crucial to reduce hospital admissions and improve outcomes for patients. This includes early detection and treatment of exacerbations by patients themselves.Aims:To explore patients’ current understanding and experience of managing and identifying COPD exacerbations at home.Methods:A qualitative, interview-based study was carried out in patients’ homes. Interviews were audio-recorded, transcribed and analysed using a grounded theory approach. Forty-four patients (17 women, 27 men; age range 55–85 years), with moderate-to-very-severe COPD, were recruited to the interview study from primary and secondary care settings in Oxford, UK, during 2012–2013.Results:Patients identified exacerbations on the basis of measurable, ‘visible’ symptoms, such as cough and sputum and ‘invisible’ symptoms, such as chest sensations and bodily knowledge. Most patients seemed to use a combination of these approaches when identifying exacerbations, according to the symptoms that had the most impact on their well-being. Patients used additional self-management strategies during an exacerbation, such as self-medication (antibiotics and steroids) and monitored their recovery. Contact with health-care professionals usually occurred when patients felt no longer able to manage themselves.Conclusions:Patients use both assessment of objective biomarkers, which are aligned with medical knowledge, and subjective symptoms based on their experience, to identify and manage exacerbations of COPD. Health-care professionals and clinicians should acknowledge this ‘expert patient’ knowledge and integrate this into patients’ care plans to facilitate early recognition and treatment of exacerbations.

Clinical Investigation on the Beneficial Effects of the Chinese Medicinal Herb Gushen Pian on Sensorineural Deafness and Tinnitus

The objective is to study the therapeutic effects of Gushen Pian on sensorineural deafness according to the Phase II clinical trial protocol, as approved for novel traditional Chinese medicines by Ministry of Health of PRC. This is a double blind study in which 120 patients were allocated randomly into treatment and control groups and an open treatment group (40 cases in each group). Patients in the treatment groups were administrated with Gushen Pian and controls received placebo. Routine examination of blood and urine, hepatic and renal function tests and pure tone audiometry were performed before and after treatment. Clinical symptoms and therapeutic outcomes were compared and evaluated. For double-blind treatment group, the total effective rate of deafness was 42.2% and total relieved rate of deafness was 4.6%; for double-blind control group, the total effective rate of deafness was 18.7% and total relieved rate of deafness was 0%; for simple treatment group, the total effective rate of deafness was 58.7% and total relieved rate of deafness was 6.3%. For double-blind treatment group, the total effective rate of tinnitus was 89.2% and total relieved rate of tinnitus was 59.5%; for double-blind control group, the total effective rate of tinnitus was 30.8% and total relieved rate of tinnitus was 5.1%; for simple treatment group, the total effective rate of tinnitus was 74.3% and total relieved rate of tinnitus was 57.1%. The double-blind treatment showed statistically significant differences from control group. The medication could effectively alleviate aural fullness, dizziness, lassitude of loins and knees, dysphoria with feverish sensation in chest, insomnia, and fatigue, etc. No adverse effect was reported during treatment; no abnormal results were reported in blood, urine, faces, heart function, liver function and kidney function examination. Gushen Pian had beneficial effect on deafness and tinnitus and could effectively alleviate aural fullness, insomnia, etc., without any adverse effects.

Recovery of Sensation in the Anterior Chest Area after Bilateral Axillo-breast Approach Endoscopic/Robotic Thyroidectomy

There is concern that endoscopic/robotic thyroidectomy could impair anterior chest skin sensation. Here, this possibility was assessed. Fifty-one patients who underwent bilateral axillo-breast approach endoscopic/robotic thyroidectomy were asked 8 to 115 days (median: 29 d) later to undergo Semmes-Weinstein pressure threshold testing and to complete a questionnaire. Patient clinicopathological details were extracted. Twenty-one patients (41.2%) showed sensory impairment (sum of sensory changes ≥ 1). The average sum of sensory change (scale of 0 to 95) was 1.4 (range, 0 to 8). Impaired patients did not differ from unimpaired patients in any clinicopathological parameter except for time from operation. Compared with 1 month postsurgery, there was significantly less sensory impairment 3 months postsurgery (P=0.0083). The questionnaires yielded similar observations. The temporary and mild nature of the sensory change in the anterior chest area will relieve surgeons and patients from concerns that bilateral axillo-breast approach endoscopic/robotic thyroidectomy could permanently impair chest sensation.

Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey

To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction. Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown. A descriptive prospective study. Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected. A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84.37% vs. 67.19%, p < 0.05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7.54 SD 2.35 vs. 7.51 SD 2.25) and reported less atypical chest pain (0.00% vs. 9.3%) compared with women. Men had more upper right sided chest pain (40.74% vs. 20.93%, p = 0.038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions. Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high-risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations. Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.